Insurance Affordability Programs Eligibility Appeals Hearing Results

This dataset includes the hearing results for eligibility appeals filed for subsidized Covered California coverage, Medi-Cal, or a combination of both eligibility determinations by year and quarter. The Department of Health Care Services (DHCS) assigns responsibility for conducting fair hearing requests (appeals) to the California Department of Social Services (CDSS). CDSS receives appeal requests, conducts hearings through their statewide network of administrative law judges, and renders decisions. CDSS provides these services to DHCS through a contract called an interagency agreement. In addition to the interagency agreement, the Delegation Order gives an Administrative Law Judge the authority to review and adopt decisions for hearings. Hearing requests (appeals) may be filed for cases involving mixed determinations, such as when household members applied for and/or had eligibility determinations made for the two programs (i.e., parents were eligible for Covered California and the child(ren) were eligible for Medi-Cal). Hearings are held when an appeal filed by an appellant for determinations that resulted in a denial, eligibility, or discontinuance of coverage. This dataset provides categories of hearing results and includes granted, granted in part, denied, or withdrawn/dismissed. This dataset is part of the public reporting requirements set forth in the California Welfare and Institutions Code 14102.5(6).

Data and Resources

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